PRESCHOOL/SCHOOL SUPPORTIVE HEALTH SERVICES PROGRAM (SSHSP)

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PRESCHOOL/SCHOOL SUPPORTIVE HEALTH

SERVICES PROGRAM (SSHSP)

MEDICAID-IN-EDUCATION

PROVIDER POLICY AND BILLING HANDBOOK

(UPDATE 7)

ISSUED APRIL 2012

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SECTION 1 GENERAL INFORMATION ... 3

PREFACE ... 3

MISSION ... 4

HISTORY OF PRESCHOOL/SCHOOL SUPPORTIVE HEALTH SERVICES PROGRAM (SSHSP) ... 4

SECTION 2 MEDICAID SERVICES ... 6

EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SERVICES (EPSDT) ... 6

SSHSP MEDICAID REIMBURSABLE SERVICES ... 6

MEDICAID PROVIDERS ... 7

SECTION 3 CONFIDENTIALITY ... 8

HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT (HIPAA) ... 8

THE FAMILY EDUCATIONAL RIGHTS AND PRIVACY ACT (FERPA) ... 8

MEDICAID ELIGIBILITY DISCLOSURE POLICIES ... 10

PROCEDURES FOR THE TRANSMISSION OF STUDENT SPECIFIC INFORMATION ... 11

SECTION 4 OTHER AVAILABLE REIMBURSEMENT ... 13

USE OF PUBLIC INSURANCE FUNDS FOR STUDENTS WITH DISABILITIES ... 13

THIRD PARTY HEALTH INSURANCE (TPHI)... 14

SECTION 504 STUDENTS ... 14

SECTION 5 SSHSP DOCUMENTATION REQUIREMENTS ... 15

SUMMARY OF MEDICAID DOCUMENTATION REQUIREMENTS ... 15

1) REFERRAL TO THE COMMITTEE ON SPECIAL EDUCATION (CSE) AND/OR THE COMMITTEE ON PRESCHOOL SPECIAL EDUCATION (CPSE) ... 16

2) INDIVIDUALIZED EDUCATION PROGRAM (IEP) ... 17

3) VERIFICATION OF CURRENT CERTIFICATION, LICENSURE, AND/OR REGISTRATION ... 18

4) PROVIDER AGREEMENT AND STATEMENT OF REASSIGNMENT ... 19

5) PARENTAL CONSENT FOR RELEASE OF INFORMATION ... 20

6) WRITTEN ORDER/REFERRAL ... 21

7) “UNDER THE DIRECTION OF” AND “UNDER THE SUPERVISION OF”... 23

8) MEDICAID DOCUMENTATION OF EACH ENCOUNTER ... 26

A) SESSION NOTES ... 26

B) EVALUATIONS ... 27

C) MEDICATION ADMINSTRATION RECORD (MAR) ... 29

D) SPECIAL TRANSPORTATION LOG ... 32

9) PROGRESS NOTES ... 33

DOCUMENTATION RETENTION POLICY ... 34

SECTION 6 SSHSP COVERED SERVICES ... 35

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PROVIDER QUALIFICATIONS AND DOCUMENTATION REQUIREMENTS ... 36

MEDICAL EVALUATION ... 38

MEDICAL SPECIALIST EVALUATION ... 39

PSYCHOLOGICAL EVALUATION ... 40 AUDIOLOGICAL EVALUATION ... 41 PHYSICAL THERAPY ... 42 OCCUPATIONAL THERAPY ... 43 SPEECH THERAPY ... 44 PSYCHOLOGICAL COUNSELING ... 45 SKILLED NURSING ... 46 SPECIAL TRANSPORTATION ... 49

SECTION 7 MEDICAID CLAIMING PROCESS ... 51

MEDICAID BILLING PROVIDER REQUIREMENTS ... 51

SSHSP BILLING/CLAIMING GUIDANCE ... 52

MEDICAID CLAIMING PROCESS RESPONSIBILITIES ... 54

MEDICAID ELIGIBLE (ME) LIST ... 54

BILLING PROCESS ... 54

PROCESSING OF A STUDENT'S MEDICAID BIOGRAPHICAL DATA... 57

CIN TRANSACTIONS ... 58

ADJUST/VOID PROCESS ... 59

DELETE TRANSACTION ... 59

MONTHLY CLAIMING/BILLING CALENDAR ... 59

MEDICAID WEB REPORTS ... 59

CNYRIC PROCESSING ERROR MESSAGES ... 59

EXCEPTIONS TO SCHOOL DISTRICTS CLAIMING MEDICAID ... 60

APPENDIX A NEW BILLING METHODOLOGY AND PROCEDURE CODES ... 61

APPENDIX B ABBREVIATIONS, ACRONYMS, AND DEFINITIONS ... 75

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PREFACE

The purpose of this Handbook is to provide information and guidance to those who coordinate and deliver related services and/or other special education programs and services to children with disabilities in the school districts, counties, and §4201 schools and who participate in the New York State Medicaid Program. Throughout this document the term counties includes the City of New York. Handbook #7 includes information to help providers understand Medicaid program requirements and instructions regarding

documentation requirements for completing and submitting Medicaid claims.

The information and instructions in Handbook 7 apply to all Medicaid claims for school supportive health services delivered on or after September 1, 2009. Handbook 7 replaces Handbook 6 and incorporates all elements of the interim billing and claiming guidance that is posted on the Medicaid in Education website at:

http://www.oms.nysed.gov/medicaid/

Pertinent policy statements and requirements governing the Medicaid Program have been included in Handbook 7, which will serve as a central reference for updated information. Providers of preschool and school supportive health services are responsible for familiarizing themselves with all Medicaid regulations, policies and procedures currently in effect and as they are issued.

In addition to Handbook 7, primary sources of information about the Preschool/School Supportive Health Services Program, which is administered jointly by the New York State Education Department (SED) and the New York State Department of Health (DOH), are:

Medicaid Alerts published by SED, which contain information regarding the provision of special education related services eligible for Medicaid reimbursement. Topics of Medicaid Alerts include the State Plan Amendment (SPA) for Preschool/School

Supportive Health Services, updates on provider qualifications and updates on billing and claiming. Medicaid Alerts can be found on the Medicaid in Education website at: www.oms.nysed.gov/medicaid

Medicaid Update, a monthly publication of DOH, which contains information regarding Medicaid programs, policy and billing. The Medicaid Update is ONLY available electronically. The newsletter is delivered monthly to your designated e-mail address in a Portable Document Format (PDF). To receive the Medicaid Update electronically, please send your e-mail address to:

[email protected] or write to:

NYS Department of Health

Office of Health Insurance Programs Attention: Kelli Kudlack

Corning Tower, Room 2029 Albany, New York 12237

Past issues of Medicaid Update, organized by month, year and by topic, are available at:

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The definitions, provider qualifications and documentation requirements included in this Handbook are for Medicaid reimbursement purposes only and may not correspond exactly to requirements for the provision of special education services as required by Federal and State law and regulations. Regardless of the requirements for Medicaid reimbursement, school districts, counties, and §4201 schools must provide special education services in compliance with Federal and State law and regulations.

MISSION

To assist school districts, counties, and §4201 schools to provide quality healthcare to students with disabilities for certain diagnostic and health support services through

accessing Medicaid reimbursement for eligible services and to prevent fraud, abuse, and false billing to the Medicaid Preschool and School Supportive Health Services Program while ensuring compliance with federal and State laws, regulations and guidelines.

HISTORY OF PRESCHOOL/SCHOOL SUPPORTIVE HEALTH SERVICES PROGRAM (SSHSP) Traditionally, all costs provided by educational institutions have been funded through

educational resources. In 1988, §1903 of subdivision (c) of the Social Security Act (SSA), was added by §411(k)(13)(A) of the Medicare Catastrophic Coverage Act of 1988 (PL 100-360). §1903(c) clarified Congressional intent by stating that nothing in Title XIX of the SSA shall preclude Medicaid coverage of services included in the Individualized Education Program (IEP) of a student with a disability. This paved the way to supplement already allocated state and local educational monies earmarked for such services with Federal Medicaid dollars without impacting the State Medicaid Budget. New York State implemented the Federal Law in 1989 by amending §§368 (d) and (e) of the Social Services Law to authorize the then State Department of Social Services (SDSS) to make payment of Federal Medicaid Assistance (MA) funds for SSHSP services. The Department of Health is now the single state Medicaid agency responsible for oversight of the New York State Medicaid program. In 2001, the Department of Justice (DOJ) and the Office of the Inspector General (OIG) initiated a federal investigation of a sample of programs in school districts, counties, and New York City as a result of litigation commenced by a whistleblower under the federal False Claims Act. This investigation provided the impetus for a complete audit of New York’s School Supportive Health Services program by the OIG. Results of the audit recommended Medicaid disallowances of approximately $1.078 billion, not including interest. In July 2009, the State and New York City entered into an agreement with the federal Centers for

Medicare and Medicaid Services (CMS), OIG and DOJ that calls for restitution of

approximately $539.75 million by the State and City. Terms of this settlement also include a Compliance Agreement that requires the State to implement a Compliance and Integrity Program to prevent fraud, abuse, and false billing to Medicaid in its Preschool and School Supportive Health Services Program. Under the Compliance Agreement, the State was also required to submit a new State Plan Amendment (SPA) for CMS approval. The SPA details the nature and scope of Medicaid coverage and reimbursement including provider qualifications and encounter-based billing methodology. SPA #09-61 for the

Preschool/School Supportive Health Services Program was approved by CMS on April 26, 2010 with a retroactive effective date of September 1, 2009.

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The Preschool/School Supportive Health Services Program (collectively “SSHSP”) was

developed jointly by the New York State Department of Education (SED) and the New York State Department of Health (DOH) to help school districts, counties, and §4201 schools obtain Medicaid reimbursement for certain diagnostic and health support services provided to students with disabilities. Specific services provided to school-age students from five years up to 21 years of age and to preschool students ages three to five years may be covered under SSHSP if all Medicaid requirements are met.

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EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SERVICES (EPSDT)

School Supportive Health Services (SSHS) are services provided by or through school districts or §4201 schools, and Preschool Supportive Health Services (PSSHS) are provided through counties in the State or New York City to children with disabilities who attend public or State Education Department approved schools or preschools. The services must be:

Medically necessary and included in a Medicaid covered category in accordance with §1905(a), §1905(r)(5), and/or §1903(c) of the Social Security Act;

Ordered or prescribed by a physician or other licensed practitioner acting within his or her scope of practice under New York State Law;

Included in the student’s Individualized Education Program (IEP);

Provided by qualified professionals under contract with or employed by a school district, a §4201 school, or a county in the State or the City of New York;

Furnished in accordance with all requirements of the State Medicaid Program and other pertinent federal and State laws and regulations including those for provider qualifications, comparability of services, and the amount, duration and scope provisions; and

Included in the State’s Medicaid plan or available under Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) services.

A school district, §4201 school, or county in the State or New York City must be enrolled as a Medicaid provider in order to bill Medicaid. Effective September 1, 2009, under State Plan Amendment #09-61, the services covered by the SSHSP for Medicaid eligible children under 21 who are eligible for EPSDT services that are medically necessary are included in Table 1.

Table 1

SSHSP MEDICAID REIMBURSABLE SERVICES

Medical Evaluations

Medical Specialist Evaluations Psychological Evaluations Audiological Evaluations Physical Therapy Occupational Therapy Speech Therapy Psychological Counseling Skilled Nursing Special Transportation

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MEDICAID PROVIDERS

For purposes of clarifying the term ‘provider,’ Medicaid claims can include three ‘providers’. These are:

Ordering provider – the professional who has ordered or recommended services. At this time, this provider’s NPI need not be identified on Medicaid claims.

Attending provider – the clinician who has the overall responsibility for the student’s medical care and treatment. In cases where the servicing provider works “under the direction of” or “under the supervision of” a licensed clinician, the

directing/supervising clinician is considered the “attending” clinician. Beginning with dates of service on or after January 1, 2012 this provider’s NPI will be identified on Medicaid claims. The attending provider’s NPI must be identified on the electronic Medicaid claim when the attending provider and the servicing provider are not the same individual.

Billing provider – the school district, county, or §4201 school. This provider’s NPI must be identified on Medicaid claims.

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HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT (HIPAA)

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) requires standards to be adopted in two areas;

1) Electronic health-care transactions (include standardizing the manner in which health services are claimed by any entity for any person in receipt of such a service), and

2) Privacy (confidentiality) of all health-related services provided. This involves protection of health information for anyone in receipt of such services.

Because the Central New York Regional Information Center (CNYRIC) submits all Medicaid claim data to the electronic Medicaid system in New York State (eMedNY) for processing on behalf of school districts, counties, and §4201 schools, it is a covered entity under this act. The electronic transmission of Medicaid data by CNYRIC is in a HIPAA-compliant format.

For more information about HIPAA please visit the US Department of Health and Human Services website at: http://www.hhs.gov/ocr/privacy/

THE FAMILY EDUCATIONAL RIGHTS AND PRIVACY ACT (FERPA)

The Family Educational Rights and Privacy Act (FERPA) (20 U.S.C. §1232g; 34 CFR Part 99) is a federal law that protects the privacy of student education records. The law applies to all schools that receive funds under an applicable program of the U.S. Department of

Education.

FERPA gives parents certain rights with respect to their children's education records. These rights transfer to the student when he or she reaches the age of 18 or attends a school beyond the high school level.

The Family Educational Rights and Privacy Act (FERPA), which is also known as the Buckley Amendment, is more restrictive than HIPAA with respect to the protection of privacy and security of all health related services. Because all school districts, counties, and §4201 schools are required to be in compliance with FERPA, they are also in compliance with HIPAA.

In order to assure compliance with FERPA (and thus with HIPAA), the following minimum procedures must be in place:

All student data files and information must be protected (e.g., student files are locked or only accessible by appropriate personnel).

Any student information/files transmitted to other appropriate recipients must also be protected. Information files must be encrypted and password protected.

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Student information/files may be faxed to appropriate personnel, but only to secure sites.

Parental consent is required for the release of any personally identifiable information other than those specifically excluded in 34 CFR §99.31.

See Procedures for Transmission of Student Specific Information For Medicaid Billing Purposes on page 11 for all communications between school districts, counties, and §4201 schools, and SED/DOH pertaining to student-specific information.

For additional information, you may call 1-800-USA-LEARN (1-800-872-5327) (voice). Individuals who use TDD may call 1-800-437-0833.

Or you may visit the US Department of Education website at: http://www2.ed.gov/policy/gen/guid/fpco/ferpa/index.html

Or you may contact the Family Policy Compliance Office at the following address: Family Policy Compliance Office

U.S. Department of Education 400 Maryland Avenue, SW Washington, D.C. 20202-8520

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MEDICAID ELIGIBILITY DISCLOSURE POLICIES

New York State Education Department Policy

Confidentiality requirements mandate parental consent is given to the school districts, counties, and §4201 schools before the identity of a special education student can be released. See page 20 for parental consent requirements.

New York State Department of Health Policy

Schools and preschools may disclose Medicaid eligibility information to their health related services professional staff and providers with whom they contract when such information is necessary to administer the Medicaid State Plan for SSHSP.

Eligibility information provided to school districts, counties, and §4201 schools, therefore, may be shared with staff and other individuals associated with the agency that must provide the documentation required to claim Medicaid reimbursement.

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PROCEDURES FOR THE TRANSMISSION OF STUDENT SPECIFIC INFORMATION FOR MEDICAID BILLING PURPOSES

To maintain security, all staff handling data with student identifying information, especially while seeking clarification on the processing of claims, must abide by the rules in this section. Staff includes, but is not limited to, employees and contracted staff of school districts, §4201 schools, counties, State agencies, Regional Information Centers (RICs), and other third party vendor staff.

Fax Transmissions

The sender should place the student last name, first name, date of birth and gender on a numbered line. This will allow the receiving staff to provide a response using only the number, without having to repeat the identifying information.

Call the receiver ahead of time to ensure immediate availability to retrieve the document. The intended receiver must provide the sender with a phone number for a fax machine that is located in a secure environment and not open to the general public.

E-Mail Transmissions

E-mail transmissions are permissible only if the data is encrypted and password protected. Information on encryption software is discussed later in this section.

Telephone

The telephone is preferable for small numbers of requests. Leave messages containing identifying data only on voice mail systems that are password protected.

Paper Documents

Printed documents may be mailed but be sure to mail only to a specific individual with the right to know. General addresses, where anyone can open the mail, are not appropriate. Hand Delivered Files

Files and printed documents with personally identifying information may be hand delivered without encrypting the files. However, the information must be hand delivered to an

appropriate individual with the right to know.

Files, Logs, Documentation or any Medium Containing Student Personally Identifiable Information

All files must be maintained in a secure environment which can only be accessed by appropriate staff that requires access to such information to carry out their work responsibilities. Information should not be left unattended. It should be locked or maintained where access would be denied.

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Encryption Information

School districts, §4201 schools, and counties may continue to use their current encryption software as long as it meets industry standards for security and privacy and is password protected. However, if you do not currently have encryption software you will need to purchase a package in order to meet FERPA requirements for security and privacy regarding the sending or transmitting of personally identifiable student information. SED does not recommend a particular software package or vendor. School districts, §4201 schools, or counties may pursue appropriate options, based on their existing infrastructure and support, and should involve their information technology support staff in deciding which option or software is in their best interest. However, SED requires that any software selected must be compatible with the Pretty Good Privacy (PGP®) software used by SED, DOH and Central New York Regional Information Center (CNYRIC). The website to inquire about the PGP Encryption Software is:

http:/www.symantec.com/business/theme.jsp?themeid=pgp

The PGP version that is most compatible for this purpose is the PGP Desktop 8.0 version. Whatever option you choose or software you use, the recipient of your data must be able to open the file with the password you choose.

File Transfer Protocol (FTP)

If your local RIC offers an electronic FTP to submit or retrieve files, the RIC takes the responsibility for securing the information and the authorization for its use. If interested in submitting or retrieving information using this process, contact your RIC for details and authorization.

Note: HIPAA expressly excludes from HIPAA coverage any information maintained in school district educational records which are subject to the Family Educational Rights and Privacy Act (FERPA). Any questions regarding the above should be addressed to:

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USE OF PUBLIC INSURANCE FUNDS FOR STUDENTS WITH DISABILITIES

The purpose of this section is to remind school districts, counties, and §4201 schools of the federal requirements relating to the use of public insurance funds for students with

disabilities. Certain students with disabilities in NYS have access to public insurance. Federal regulations establish that a public agency may use a student’s Medicaid or other public insurance benefit programs in which a student participates to provide or pay for school supportive health services with the following limitations:

School districts, counties, and §4201 schools cannot:

Require parents to sign up for or enroll in public insurance programs in order for their child to receive a free appropriate public education (FAPE) under Part B of the Individuals with Disabilities Education Act (IDEA);

Require parents to incur an out-of-pocket expense such as the payment of a deductible or co-pay amount incurred in filing a claim for services, but may pay the cost that the parent otherwise would be required to pay; and

Use a child’s benefits under a public insurance program if that use would: o Decrease available lifetime coverage or any other insured benefit;

o Result in the family paying for services that would otherwise be covered by the public insurance program and that are required for the child outside of the time the child is in school;

o Increase premiums or lead to the discontinuation of insurance; or o Risk loss of eligibility for home and community-based waivers, based on

aggregate health-related expenditures.

The use of Medicaid funds to provide or pay for school supportive health services through New York State’s Preschool/School Supportive Health Services Program will not:

Require parents to incur an out-of pocket expense;

Decrease a child’s Medicaid benefits or available lifetime coverage; or Increase premiums or lead to the discontinuation of insurance or a student’s eligibility for home and community-based waivers.

Special Note: Section 5 of this Handbook provides detailed information regarding IDEA written parental consent requirements. In addition, parents must be informed that refusal to permit the school district, county, or §4201 school to access public benefits or insurance does not relieve the school district, county, or §4201 school of its responsibility to ensure that all required services are provided to students at no cost to parents.

Additional information regarding the use of public insurance is available at

http://www.p12.nysed.gov/specialed/publications/medicaidparentalconsent.htm. If you have any questions regarding the above requirements, please contact the SED Medicaid Unit at 518-474-7116 or [email protected].

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THIRD PARTY HEALTH INSURANCE (TPHI)

Preschool/School Supportive Health Service Program (SSHSP) providers do not have to bill a student’s third party health insurance before Medicaid can be billed for SSHSP services. The NYS Office of the Medicaid Inspector General (OMIG) is able to identify students that have third party insurance coverage and pursue recovery of SSHSP Medicaid costs from the insurance carrier.

Preschool/School Supportive Health Services are carved out (not included in) of the

Medicaid Managed Care benefit package. This means that SSHS are billed to regular fee-for-service Medicaid for students enrolled in Medicaid Managed Care.

SECTION 504 STUDENTS

Medicaid reimbursement is not available for students receiving services from an

Accommodation Plan in accordance with Section 504 of the Rehabilitation Act. Section 504 Accommodation Plans do not meet federal or State requirements for Medicaid reimbursement.

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SUMMARY OF MEDICAID DOCUMENTATION REQUIREMENTS

In order to submit claims to the Medicaid program for SSHSP services, certain documentation requirements must be met. Some of the requirements listed in this section are solely

federal/state education requirements (#1, #5, and #9) and others are both federal and/or State Medicaid/education requirements (#2, #3, #4, #6, #7, and #8). Effective September 1, 2009, billing for SSHS is encounter-based and a session note is required to document each service (session) delivered to an eligible student. Required documentation listed here is explained further in this section. Items #1,#5, and #9 are not explicitly required for Medicaid billing purposes; however, they are required as part of the special education process. Items #2, #3, #4, #6, #7, and #8 are the documentation that must be on file for every student receiving school supportive health services in order to bill Medicaid.

In summary, necessary documentation includes:

1) Referral to the Committee on Special Education (CSE) and/or the Committee on Preschool Special Education (CPSE).1

2) The Individualized Education Program (IEP). For Medicaid claiming purposes all school supportive health services to be provided and all evaluations used in the IEP

development must be on the student's IEP.

3) Verification of current certification, licensure, and/or registration, as relevant, of clinician providing the service must be available upon request.

4) Provider Agreement and Statement of Reassignment completed by outside contractors, if applicable.

5) Parental Consent for Release of Information. 6) Written Orders/Referrals.

7) “Under the Direction of” or “Under the Supervision of” documentation, if applicable. 8) Documentation of each billable service:

A. Evaluation report. B. Session note.

C. Medication Administration Record (MAR). D. Special transportation logs.

9) Progress notes.

SSHSP document retention requirements are listed at the end of this section.

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1) REFERRAL TO THE COMMITTEE ON SPECIAL EDUCATION (CSE) AND/OR THE COMMITTEE ON PRESCHOOL SPECIAL EDUCATION (CPSE)

§200.4 (a) Referral. A student suspected of having a disability shall be referred in writing to the chairperson of the district's committee on special education or to the building

administrator of the school which the student attends or is eligible to attend for an individual evaluation and determination of eligibility for special education programs and services. The school district must initiate a referral and promptly request parental consent to evaluate the student to determine if the student needs special education services and programs if a student has not made adequate progress after an appropriate period of time when provided instruction as described in section 100.2(ii) of this Title.

For additional information, refer to Part 200.4(a) of the Regulations of the Commissioner of Education at: http://www.p12.nysed.gov/specialed//lawsregs/sect2004.htm

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2) INDIVIDUALIZED EDUCATION PROGRAM (IEP)

The IEP is the cornerstone of the special education process for each individual student with a disability. It is designed to enable a student with a disability to receive a free appropriate public education (FAPE) or to benefit from special education. It is the tool used to

document how one student’s special needs related to his/her disability will be met within the context of an educational environment. For Medicaid claiming purposes, all school

supportive health services, including evaluations, must be documented in the student’s IEP. Each student with a disability must have an IEP in effect by the beginning of each school year. Federal and State laws and regulations specify the information that must be

documented in each student’s IEP. In NYS, IEPs developed for the 2011-12 school year, and thereafter, must be on a form prescribed by the Commissioner of Education.

An IEP identifies a student’s unique needs and how the school will strategically address those needs. IEPs identify how specially designed instruction will be provided in the context of supporting students in the general education curriculum and in reaching the same learning standards as students without disabilities. IEPs guide how the special education resources of a school will be configured to meet the needs of the students with disabilities in that school. IEPs identify how students will be incrementally prepared for adult living. IEPs also provide an important accountability tool for school personnel, students and parents. By measuring students’ progress toward goals and objectives, schools should use IEPs to determine if they have appropriately configured how they use their resources to reach the desired outcomes for students with disabilities.

For additional information about IEP development and the required IEP form, refer to the following website: http://www.p12.nysed.gov/specialed/formsnotices/IEP/home.html In order to be Medicaid reimbursable, SSHSP services must be included in the student’s IEP.

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3) VERIFICATION OF CURRENT CERTIFICATION, LICENSURE, AND/OR REGISTRATION AS RELEVANT

Providers of SSHSP services are required to meet certain qualifications as defined in the New York State Plan Amendment #09-61 and federal and State laws and regulations. It is the responsibility of Medicaid billing providers (school districts, counties, and §4201 schools) to verify qualifications prior to submitting claims for Medicaid reimbursement.

Verification of practitioner qualifications must be kept on file or be available if requested for audit purposes.

Verification of clinicians’ credentials can be done in various ways. Examples include: Request that practitioners submit documentation of current New York State certification, licensure and/or registration, as required, on an annual basis.

Verify license and registration credentials on SED’s Office of Profession’s website at: http://www.op.nysed.gov/opsearches.htm

Verification of a teacher’s certification can be accessed through SED’s Teach Public Inquiry System online at:

http://eservices.nysed.gov/teach/certhelp/CpPersonSearchExternal.jsp?trgAction=IN QUIRY

Reminder: Services rendered by certified teachers are not Medicaid reimbursable, with the exception of speech therapy rendered by certified teachers of the speech and hearing handicapped (TSHH) and certified teachers of students with speech and language disabilities (TSSLD) under the direction of a licensed and currently registered Speech Language Pathologist.

Licenses and PTA and OTA certificates are issued by the Office of Professions; all other certificates are issued by the Office of Teaching Initiatives.

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4) PROVIDER AGREEMENT AND STATEMENT OF REASSIGNMENT

In order for school districts, counties, and §4201 schools to claim Medicaid reimbursement for services, they must have all private agencies, or service providers with whom they contract (other than a Board of Cooperative Educational Services (BOCES)), sign a Provider

Agreement and a Statement of Reassignment. Specifically, if a school district, county, or §4201 school contracts directly for a service such as transportation or speech therapy with an agency or person who is not an employee of the school district, county, §4201 school, or BOCES, that provider must have signed the Provider Agreement and the Statement of Reassignment. An independent agency may be an individual person or a corporation. The Provider Agreement requires the contractor to “keep any record necessary to disclose the extent of services the Provider furnishes to recipients receiving assistance under the New York State Plan for Medical Assistance.”

The Statement of Reassignment requires the contractor “to reassign all Medicaid

reimbursements to your school district [county, §4201 school] that you contracted with for providing medical services billed under the School Supportive Health Services Program.” A Provider Agreement and Statement of Reassignment are needed from each contracted agency, but not from each individual service provider within the contracted agency. It is recommended that school districts, counties, and §4201 schools review these forms at the time of contract renewal.

The Provider Agreement and the Statement of Reassignment can be found at: http://www.oms.nysed.gov/medicaid/resources/

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5) PARENTAL CONSENT FOR RELEASE OF INFORMATION

Medicaid may not be billed for school supportive health services furnished to a student without a separate signed parental consent that meets IDEA and FERPA requirements. Information on parental consent can be found online at:

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6) WRITTEN ORDER/REFERRAL

The written order/written referral (prescription) is the documentation that establishes medical necessity for the related service to be furnished and constitutes medical direction of the ordering professional. In order to bill Medicaid, a written order/written referral is required. Written orders/written referrals must be prospective and must be kept on file. Faxed copies of the written order/referral are acceptable.

The following elements must be included on a written order: The name of the child for whom the order is written; The complete date the order was written and signed;

The service(s) being ordered. Note: The frequency and duration of the ordered

service must be either specified on the order itself or the order can explicitly adopt the frequency and duration of the service in the IEP by reference;

Ordering provider’s contact information (office stamp or preprinted address and telephone number);

Signature* of a NYS licensed, registered, and/or certified, as relevant, physician, physician assistant, or licensed nurse practitioner acting within his or her scope of practice (for psychological counseling services, this also includes an appropriate school official and for speech therapy services, a NYS licensed and registered speech-language pathologist**);

The time period for which services are being ordered;

The ordering practitioner’s National Provider Identifier (NPI) or license number; and, Patient diagnosis and/or reason/need for ordered service(s).

* Please note that stamped signatures are not allowable.

**For purposes of the SSHSP, where written referrals are permitted (e.g., speech therapy services, psychological counseling services), the written referral must include the information listed above.

It should be noted that the written order/written referral must be in place prior to the initiation of services (prospective), including evaluations.

Life of a Written Order/Referral

A written order/referral is required for Medicaid reimbursement for services included in the IEP. The written order/referral for service(s) must be obtained when the frequency or duration for the service(s) is changed or when an annual review is completed and an IEP is developed.

18 NYCRR 515.2(b)(1)(c) states that an unacceptable practice is conduct which constitutes fraud or abuse and includes submitting, or causing to be submitted, a claim or claims for medical care, services or supplies provided at a frequency or in an amount not medically necessary. This means that SSHSP providers cannot bill Medicaid for services that are in excess of those specified on the written order/referral. If the frequency and duration of the ordered services are not explicitly stated then there is no documentation of the determination of the medically necessary of those services and therefore they cannot be billed to Medicaid.

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There must be a valid written order/referral annually or whenever there is a change in

services for Medicaid to be billed.

For example, a written order, dated 5/5/10, for physical therapy for the time frame of 7/1/10 – 6/30/11 is received by the Committee on Special Education (CSE). On 5/16/10 the CSE met and developed the IEP for the 2010/2011 school year and included physical therapy in the IEP for 3 sessions a week. After the student’s most recent physical therapy evaluation (November 2010), the CSE agreed to decrease services to 2 sessions a week. Because this is a change in both the IEP and treatment, a new written order must be obtained in order for Medicaid to be billed.

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7) “UNDER THE DIRECTION OF” AND “UNDER THE SUPERVISION OF”

To be Medicaid reimbursable, clinicians furnishing services must possess certain

qualifications, including New York State licensure, registration, or certification as appropriate. For SSHSP purposes, the “under the direction of” requirements apply to speech teachers and therapy assistants in physical and occupational therapy as relevant, while the “under the supervision of” requirement applies to licensed master social workers (LMSWs). Licensed practical nurses (LPNs) must be under the direction of a licensed registered professional nurse (RN), physician, or other licensed health care provider authorized under the Nurse Practice Act. “Under the direction of” requirements are different for LPNs, additional information can be found in the SSHSP Questions and Answers that are posted on the Medicaid in Education webpage.

Occupational and physical therapy assistants must have direction from a licensed practitioner in their discipline, while teachers of the speech and hearing handicapped (TSHH) and teachers of students with speech and language disabilities (TSSLD) must receive direction from a licensed speech-language pathologist. Licensed master social workers (LMSWs) must receive supervision from a licensed and registered psychiatrist, psychologist, or licensed clinical social worker (LCSW). Supervision requirements applicable to LMSWs

providing SSHSP services are defined by the State Education Department’s Office of the Professions and are located at http://www.op.nysed.gov/prof/sw/.

The various professionals that can provide school supportive health services are listed in a table on page 25. Provider qualifications are also summarized in the SSHSP Provider Matrix on pages 36 and 37. Section 6 of this Handbook provides greater detail about the

qualifications necessary for clinicians’ services to be Medicaid reimbursable.

“Under the direction of” (applies to PTA, OTA, TSHH, and TSSLD) means that the qualified practitioner:

Sees the student at the beginning of and periodically during treatment;

Is familiar with the treatment plan as recommended by the referring physician or other licensed practitioner of the healing arts practicing under State law;

Has input into the type of care provided;

Has continued involvement in the care provided, and reviews the need for continued services throughout treatment;

Assumes professional responsibility for the services provided under his or her direction and monitors the need for continued services;

Spends as much time as necessary directly supervising services to ensure students are receiving services in a safe and efficient manner in accordance with accepted standards of practice;

Ensures that providers working under his or her direction have contact information to permit them direct contact with the supervising (directing) therapist as necessary during the course of treatment;

Keeps documentation supporting the supervision of services (including meetings and observations) and ongoing involvement in the treatment of each student.

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“Under the supervision of” requirements apply only to licensed master social workers

(LMSWs) and are described here.

Supervision of the psychological counseling services provided by the LMSW, with respect to each Medicaid beneficiary (student), shall consist of contact between the LMSW and supervisor during which:

The LMSW apprises the supervisor of the diagnosis and treatment of each client; The LMSW’s cases are discussed;

The supervisor provides the LMSW with oversight and guidance in diagnosing and treating clients;

The supervisor regularly reviews and evaluates the professional work of the LMSW; and The supervisor provides at least one hour per week or two hours every other week of in-person individual or group clinical supervision, provided that at least two hours per month shall be individual clinical supervision. Effective 12/8/10, changes were made to the LMSW supervision requirements found in section 74.6 of the Regulations of the Commissioner of Education. As of 12/8/10, the supervisor is required to provide at least two hours per month of in-person individual or group clinical supervision.

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“UNDER THE DIRECTION OF”/“UNDER THE SUPERVISION OF” CHART

SERVICE PROVIDER _{“Under the Supervision Of”}“Under the Direction Of”/

Speech-Language

Services

Speech-Language Pathologist (SLP) N/A

Teacher of the Speech and Hearing Handicapped (TSHH)

Under the direction of a Speech-Language Pathologist Teacher of Students with Speech and

Language Disabilities (TSSLD)

Under the direction of a Speech-Language Pathologist Physical

Therapy

Physical Therapist (PT) N/A

Physical Therapy Assistant (PTA) Under the direction of a Physical Therapist

Occupational Therapy

Occupational Therapist (OT) N/A

Occupational Therapy Assistant (OTA) Under the direction of an Occupational Therapist Psychological Evaluations Psychiatrist N/A Psychologist N/A Psychological Counseling Services Psychiatrist N/A Psychologist N/A

Licensed Clinical Social Worker (LCSW) N/A

Licensed Master Social Worker (LMSW) Under the supervision of an LCSW, psychiatrist, or psychologist

Skilled Nursing

Registered Professional Nurse (RN) N/A

Licensed Practical Nurse (LPN)

Under the direction of a licensed registered professional nurse, physician,

or other licensed health care provider authorized under the Nurse Practice Act Medical

Evaluation

Physician N/A

Physician Assistant N/A

Nurse Practitioner N/A

Medical Specialist Evaluation

Physician Specialist N/A

Physician Assistant N/A

Nurse Practitioner N/A

Audiological

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8) MEDICAID DOCUMENTATION OF EACH ENCOUNTER

Documentation requirements to support Medicaid claims for therapy sessions, evaluations and re-evaluations, medication administration, and special transportation are described in this section.

A) SESSION NOTES

Service providers must maintain contemporaneous records. Session notes specifically

document that the servicing provider delivered certain diagnostic and/or treatment services to a student on a particular date. Session notes must be completed by all qualified providers furnishing the services authorized in a student’s IEP for each Medicaid service delivered and must include:

Student’s name

Specific type of service provided

Whether the service was provided individually or in a group (specify actual group size) The setting in which the service was rendered (school, clinic, other)

Date and time the service was rendered (length of session – record session start time and end time)

Brief description of the student’s progress made by receiving the service during the session

Name, title, signature and credentials of the servicing provider and signature/credentials of supervising clinician as appropriate

The duties of the provider are discussed in Social Services regulation at 18 NYCRR §504.3(a). Medicaid providers must prepare and maintain contemporaneous records that demonstrate the provider’s right to receive payment under the Medicaid program. “Contemporaneous” records means documentation of the services that have been provided as close to the conclusion of the session as practicable. In addition to preparing contemporaneous records, providers in the Medicaid program are required to keep records necessary to disclose the nature and extent of all services furnished and all information regarding claims for payment submitted by, or on behalf of, the provider for a period of six years from the date the care, services or supplies were furnished or billed, whichever is later.

SAMPLE SESSION NOTE – (Includes all Medicaid-required elements)

Student Name: John Smith Service Type: Speech Therapy Date: December 10, 2010 Location: Springdale Elementary Time in/Time out: 10:00am /10:30am Indiv (I) Group (G) (incl # in group): I Practitioner Name: Martha Clark

Session Note: During this session John produced initial, medial, and final /l/ with 80% accuracy in words. John is demonstrating good progress. He continues to improve his production of the /l/ in all

positions in single words.

Martha Clark,, TSHH Mary Brown, SLP

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B) EVALUATIONS

Students without an IEP in place (initial evaluation)

An initial evaluation is the evaluation(s) that is done prior to the development of a student’s first Individualized Education Program (IEP). The initial evaluation(s)for psychological

counseling, physical therapy, occupational therapy, and speech therapy are not Medicaid reimbursable unless an IEP is developed which includes a recommendation for ongoing services in the same therapy type for which the student was evaluated. In addition, all other Medicaid requirements must be met:

The written order/referral (dated prior to the evaluation) must be on file, The evaluation must be provided by a Medicaid qualified provider, The evaluation must be documented, and

The evaluation must be included in the IEP.

A written report must also be completed at the end of each evaluation. The State’s IEP form includes an Evaluation Results section as a place to document the results of evaluations that were conducted and considered in the development of the student’s IEP. Alternatively, the Committee on Special Education (CSE)/Committee on Preschool Special Education (CPSE) could document its consideration of the evaluation and assessment results under the four need areas (academic achievement, functional performance and learning characteristics; social development; physical development; and management needs).

It is important to note that IDEA-driven evaluations are Medicaid reimbursable only for students determined to have a disability.

Students with an IEP in place

For students with an existing IEP, all SSHSP evaluations are Medicaid reimbursable regardless of whether ongoing services will be included in the student’s IEP or not, as long all Medicaid requirements are met (see above).

RE-EVALUATIONS

A CSE is responsible for arranging an appropriate re-evaluation of a student with a disability. A re-evaluation review must occur at least once every 36 months unless the parent and school district agree in writing that the re-evaluation is not necessary to provide current assessment information for a student in special education. In addition, the CSE/CPSE must arrange for a evaluation more frequently if the needs of the student warrant a

re-evaluation or if requested by the student’s teacher or parent. A re-re-evaluation cannot be conducted more frequently than once a year unless the parent and school district

representative on the CSE agree otherwise.

If an additional re-evaluation to identify a student’s health related needs is deemed to be necessary, the re-evaluation is eligible for Medicaid reimbursement once it is conducted and reflected in the student’s IEP, regardless of whether or not the services will continue to be included in the student’s IEP. The CSE/CPSE must review the results of the re-evaluation and to revise the student’s IEP, if appropriate. Re-evaluations are Medicaid reimbursable as long as all Medicaid requirements are met.

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Initial Evaluation Completed

Was an IEP

developed?

Are ongoing

services (in that

same therapy type)

included in the

IEP?

END

Medicaid does not reimburse for

an initial evaluation if an IEP is not

developed.

END

Medicaid does not reimburse for

an initial evaluation if ongoing

services in the same therapy

type are not included in the IEP.

END

The initial evaluation is Medicaid

reimbursable because ongoing

services (in the same therapy type

as the evaluation) are included in

the IEP.

PRESCHOOL/SCHOOL SUPPORTIVE HEALTH SERVICES PROGRAM (SSHSP)

WHEN ARE INITIAL EVALUATIONS MEDICAID REIMBURSABLE?

N

Y

N

Y

CPSE/CSE meets

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C) MEDICATION ADMINSTRATION RECORD (MAR)

School nursing personnel should maintain accurate records of the medication administered, any special circumstances related to the procedure, and students reactions/responses. Nursing personnel must maintain an individual daily medication record for each student taking medication during the time frame medication is being given.

The medication log (MAR) must include: Student’s name and date of birth Grade/school

Medication name, dosage, and route Order start date

Order expiration date

Prescriber’s name/telephone number Parent’s name/telephone number

Date, time, and dosage of medication administered

Signature and title of the person administering medication*

*If services are delivered by an LPN, the MAR does not need to be co-signed by the RN. Nursing documentation should be accurate, objective, concise, thorough, timely, and well organized. All entries for paper records should be legible and written in ink that can be photocopied easily (black ink is recommended). The date and exact time should be

included with each entry. A sample Medication Administration Record (MAR) can be found on pages 30 and 31.

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MONTHLY MEDICATION ADMINISTRATION RECORD (P.1OF 2)

Student Name: DOB: __________School/District______________________________________ Grade:_____ Parent/Guardian: _________________________________tel#___________ Physician/NP/PA: ______________________________tel#______________ Medication Order: Medication Name/Dose: ___________________Route: ___________ Order start date (MM/DD/YY):___________ Order expiration date (MM/DD/YY): ____________________________

Medication Administration Procedure Codes: T1002 — RN services up to 15 min. or T1003 — LPN services up to 15 min.

Date Time Dose Exception Code Reaction Signature/title

 Out of med.  Absent  Refused  Field trip

 Other (see notes)  Adverse (see notes) Appropriate  Out of med.  Absent  Refused  Field trip

 Other (see notes)  Adverse (see notes) Appropriate  Out of med.  Absent  Refused  Field trip

 Other (see notes)   Appropriate Adverse (see notes)

 Other (see notes)  Adverse (see notes) Appropriate  Out of med.  Absent  Refused  Field trip

 Other (see notes)  Adverse (see notes) Appropriate

 Other (see notes)   Appropriate Adverse (see notes)  Out of med.  Absent  Refused  Field trip

 Other (see notes)  Adverse (see notes) Appropriate

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Additional Documentation

Monthly Medication Administration Record (p.2 of 2)

_________________________________________________________________________________________________________________________________ _________________________________________________________________________________________________________________________________ _________________________________________________________________________________________________________________________________ _________________________________________________________________________________________________________________________________ _________________________________________________________________________________________________________________________________ _________________________________________________________________________________________________________________________________ _________________________________________________________________________________________________________________________________ _________________________________________________________________________________________________________________________________ _________________________________________________________________________________________________________________________________ _________________________________________________________________________________________________________________________________ _________________________________________________________________________________________________________________________________ _________________________________________________________________________________________________________________________________ _________________________________________________________________________________________________________________________________ _________________________________________________________________________________________________________________________________ _________________________________________________________________________________________________________________________________ _________________________________________________________________________________________________________________________________ _________________________________________________________________________________________________________________________________ _________________________________________________________________________________________________________________________________ _________________________________________________________________________________________________________________________________ _________________________________________________________________________________________________________________________________ _________________________________________________________________________________________________________________________________ _________________________________________________________________________________________________________________________________ _________________________________________________________________________________________________________________________________ _________________________________________________________________________________________________________________________________

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D) SPECIAL TRANSPORTATION LOG

Special transportation recommended by the Committee on Special Education (CSE) and Committee on Preschool Special Education (CPSE) and identified on the students’ IEP may be eligible for Medicaid reimbursement. Special transportation can only be billed on a day that a Medicaid reimbursable service (other than transportation) was delivered and may only be billed at the rate for each one-way trip.

Claims for Medicaid reimbursement for special transportation must be supported by the following documentation:

The IEP must specify the nature (reason/need) of the student’s special transportation needs;

The Medicaid reimbursable services to be delivered to the child must also be included in the child’s IEP;

Session notes for the Medicaid reimbursable service (other than transportation) delivered to the student.

The bus/transportation log must include: The student’s name;

Both the origination of the trip and time of pickup; Both the destination of the trip and time of drop off; Bus number or the vehicle license plate number; and,

The full printed name of the driver providing the transportation.

The full address of each origination and destination must be documented. However, this does not necessarily have to be recorded on each daily transportation log. For example, in a situation when routine special transportation services are provided from the student’s home to the school it is sufficient to use the terms ‘home’ and ‘school’ on the daily log and to document the full street addresses separately in the student’s record.

It is acceptable for the transportation log to indicate the actual time the first student was picked up and the actual time the last student was dropped off. For example, when the same bus is transporting the same students from their homes to the school in the morning the

transportation log could indicate the time and place the first student is picked up and the time and place all the students are dropped off. The bus manifest and/or schedule may serve as documentation of the pickup locations and times in between the first pick up and the last drop off.

It is not necessary for the provider to create a separate special transportation log for each Medicaid eligible student.

These items are considered unacceptable documentation of a trip: a driver or vehicle manifest, or dispatch sheet; an issuance of prior authorization by the authorizing agent with subsequent checkmarks on a prior authorization roster; or an attendance log from the school or program.

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Section 5 SSHSP DOCUMENTATION REQUIREMENTS

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9) PROGRESS NOTES

Quarterly progress notes are an IDEA requirement. Although they are not required for Medicaid reimbursement, practitioners must complete quarterly progress notes to fulfill documentation requirements under IDEA. This information is included here for

convenience and to differentiate this requirement from the Medicaid program

requirement for encounter-based contemporaneous session notes. Progress notes are completed, at a minimum quarterly, by the service provider and must include the progress the student is making towards his/her goals as indicated in the student’s IEP.

Appearance

The notes should address the goals set in the IEP and should describe how the student is reaching those goals. Progress notes containing one or two word phrases do not

adequately describe a student's progress. Frequency

Progress notes are required, under IDEA and Part 200 of the Commissioner's Regulations, to be provided to parents at the time specified in the IEP. An annual review that contains progress notes by appropriate providers qualifies as one progress note.

Report of Progress

The IEP must identify when periodic reports on the progress the student is making toward the annual goals will be provided to the student’s parents (such as through the use of quarterly or other periodic reports that are concurrent with the issuance of report cards).

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Section 5 SSHSP DOCUMENTATION REQUIREMENTS

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DOCUMENTATION RETENTION POLICY

Section 517.3(b) of Title 18 NYCRR regulates audit and record retention for the NYS Medicaid program. As this section indicates, providers must retain records for a period of six years from the date the care, services or supplies were furnished or billed, whichever is later. The full text is included here for convenience:

18 NYCRR 517.3(b)(1)... All records necessary to disclose the nature and extent of services furnished and the medical necessity therefore, including any prescription or fiscal order for the service or supply, must be kept by the provider for a period of six years from the date the care, services or supplies were furnished or billed, whichever is later.

In addition, student cumulative health records, which include treatment records, are to be kept until the student reaches the age of 27. The document recording records retention can be found at: http://www.archives.nysed.gov/a/records/mr_pub_ed1.pdf

Individual professions may have other documentation and record retention requirements in addition to the Medicaid program and education requirements noted. Clinicians can access discipline-specific record retention requirements on the Office of Professions website.

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COVERED SERVICES

Included in the section of covered services are definitions, provider qualifications, and documentation requirements that are necessary to claim Medicaid reimbursement for the provision of certain diagnostic and health related support services provided to students with disabilities.

Medical Evaluation

Medical Specialist Evaluation Psychological Evaluation Audiological Evaluation Physical Therapy Occupational Therapy Speech Therapy Psychological Counseling Skilled Nursing Special Transportation

Note: These definitions, provider qualifications and documentation requirements are for Medicaid reimbursement purposes and may not correspond exactly to criteria for the provision of special education services as required by IDEA. School districts, counties, and §4201 schools must also be in compliance with the provisions of IDEA.

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NOTE: To be Medicaid reimbursable a service must be: supported by a valid written order/referral and delivered by an approved Medicaid service provider1

acting within his/her scope of practice; the encounter must be documented to support Medicaid claims; and it must be included in the IEP. Supporting documentation must be retained for a minimum of six (6) years from the date the service was furnished or billed, whichever is later.

PRESCHOOL/SCHOOL SUPPORTIVE HEALTH SERVICES PROGRAM (SSHSP) PROVIDER QUALIFICATIONS AND DOCUMENTATION REQUIREMENTS

SERVICES2 ORDERING/REFERRING REQUIREMENTS FOR MEDICAID

REIMBURSEMENT APPROVED MEDICAID SERVICE PROVIDER

DOCUMENTATION REQUIRED FOR EACH ENCOUNTER FOR MEDICAID BILLING PURPOSES

Speech Therapy

Signed/dated written order or referral from a physician, physician assistant, nurse practitioner or speech-language pathologist (SLP) who is currently licensed, registered and/or certified as required

Written order/written referral included in student’s record

Currently licensed and registered SLP or a certified teacher of the speech and hearing handicapped (TSHH)/certified teacher of students with speech and language disabilities (TSSLD) operating under the direction of a licensed and registered SLP

Evaluation: Report3 Ongoing Therapy: Contemporaneous Session Notes4 Physical Therapy

Signed/dated written order from a physician, physician assistant, or nurse practitioner who is currently licensed, registered and/or certified as required

Written order included in student’s record

Currently licensed and registered physical therapist5_{or a}

certified physical therapy assistant (PTA) operating under the direction of a licensed and registered physical therapist5 Evaluation: Report3 Ongoing Therapy: Contemporaneous Session Notes4 Occupational Therapy

Currently licensed and registered occupational therapist or a certified occupational therapy assistant (OTA) operating under the direction of a licensed and registered occupational therapist Evaluation: Report3 Ongoing Therapy: Contemporaneous Session Notes4 Psychological Counseling

Referral by an appropriate school official, such as a school administrator or the chairperson of the CSE/CPSE or other licensed practitioner acting within his/her scope of practice

Referral included in the student’s record

Currently licensed and registered psychiatrist,

psychologist, licensed clinical social worker (LCSW) or licensed master social worker (LMSW) operating under the supervision of a licensed and registered psychiatrist, psychologist or LCSW Ongoing Therapy: Contemporaneous Session Notes4 Skilled Nursing

Currently licensed and registered professional nurse (RN) or currently licensed and registered practical nurse(LPN) under the direction of an RN, a physician, or other licensed and registered health care provider in accordance with the Nurse Practice Act

Medication Administration: Medication Administration Record (MAR) Other Services: Contemporaneous Session Notes4